In our last blog post, we talked about preparing you for your total knee replacement (TKR). That post included 5 areas you should address prior having TKR surgery. We are now shifting from the prehab portion to the rehab portion of your recovery. During this stage, you are going to see many different medical professionals, depending on your overall health, living conditions and level of family support. We would like to focus on three different areas to help you recover quickly. These are your environment, pain/swelling and exercises.
Area #1 – Environment
Soon after you awake from your anesthesia, you will see a physical therapist. The therapist’s goals are to get you up and moving, show you your exercises and determine your pain level with the activities.
In our prehab blog, one of the reasons we wanted you to start specific exercises is because they will also typically be used during your first two weeks after surgery. When the physical therapist comes in right after surgery, you are going to be groggy. And trying to learn new exercises at that time will not be easy. But, by doing the exercises several weeks before surgery, you already turned them into a habit.
The average hospital stay is from one to three days. During this time, it is important to do your exercises, control your swelling and rest to allow your body to heal.
After you are discharged from the hospital, there are typically three settings you can go to. The first is your home. If you do go home, your physician may want you to start physical therapy through telemedicine, home health or in an outpatient arrangement. Each of these options has their benefits.
Telemedicine is convenient and affordable. You can make an appointment from your smartphone or computer and receive treatment without leaving your house. This may be the right choice for you if you are motivated or have high-deductible insurance. A study using telemedicine for the treatment of total knee replacements in Journal of Bone and Joint Surgery concluded that “The outcomes achieved via telerehabilitation at six weeks following total knee arthroplasty were comparable with those after conventional rehabilitation.” A pilot study published in The International Journal of Telerehabilitation found the satisfaction of participants with in-home telerehabilitation services was very high. A TeleTherapy Direct physical therapist will be honest and tell you if your are a candidate for this type of physical therapy. If the therapist decides that TeleTherapy Direct is not appropriate, they will recommend a suitable alternative, such as home health or outpatient therapy.
Home health may be prescribed if you can’t make it to an outpatient facility. The benefit is that the home health agency can have a physician, nurse, physical therapist or occupational therapist come into your environment. They will also be there, in person, to help guide you through your exercise, motivate you and place their hands on you to help you gain back your range of motion (ROM). As you improve, your therapist and physician will usually recommend outpatient physical therapy.
Outpatient therapy is a good option because it will get you out of the house and moving. Another benefit of outpatient therapy is the often overlooked social component. It is nice getting out of the house and seeing others who are going through rehab. You may even see a few friends there. A typical facility will have tables and equipment to help you progress quickly through your rehabilitation. Most outpatient therapy clinicians will be putting their hands on you to help you regain your motion, control swelling and improve your function. Another added benefit is that they have more equipment to help your exercises progress. Teletherapy can also help with this if you belong to a gym and have a smartphone.
A Rehabilitation Facility
It used to be that most patents visited a rehabilitation facility after a TKR. Those numbers have been dwindling over recent years as surgical techniques and pain control have improved. A rehabilitation facility might be the right choice for you if you need intensive physical therapy and occupational therapy. It would also be the right choice if you have other health conditions or no one to help you at home. Talk to your physician prior to surgery to determine if you will need to go to a rehab facility so you can make arrangements prior to surgery.
Area #2 – Pain and Swelling
This is a major surgery. You are going to have pain. (Look it up on YouTube.) You will be asked about your pain levels multiple times because we adjust your exercises partially by how much pain you are currently having. One of the challenges that I believe physical therapists are having with pain management is the expectation of how much pain you should have. I think the public has come to believe that you should experience no pain after surgery or injury when it is, in fact, part of the injury. Medication can help cope with this initial pain. Successful use of medication would be a decrease in pain of up to 30%. Taking your medication as prescribed by your physician will help control it. The physical therapy and exercise you will be performing will also bring relief. I use the statement that “motion is lotion” with my patients all the time. The more you move the better you will feel.
Swelling is the enemy of regaining your motion. It is important that your ice your knee and elevate it several times a day. It is also important to keep your T.E.D. hose (compression stockings) on if your doctor prescribed them. The sooner you get your swelling under control, the sooner your ROM increases, pain decreases and function improves
Area #3 – Exercises
An exercise program specific to you will be developed. It will include exercises for all of your muscle groups, range of motion and functions, such as transfers and walking. Your therapist might have you perform quad sets (tightening your thigh), straight leg raises, hip abduction (moving your leg out to the side), short arc quad (think of straightening your knee with coffee can under your knee), sit-to-stands and heel slides.
The key is speaking with your therapist about your progression. If you are only progressing your program when you see the therapist, you may be slowing your recovery down. I like to have my patients grade the difficulty or ease of the exercise on a scale of 0-10. Zero is “I did not know I was doing an exercise,” and 10 is, “One repetition was one too many.” I have a tracking grid on which they track the ease of the exercise. When the ease is less than or equal to 3, then they are to increase the reps to a set amount or increase the resistance. By doing this, my patients are in control and progressing their programs because I have educated them.
Remember, this is your rehab. No matter what setting you are in, you should be writing your questions down. Understand that this is your appointment and your are in charge. The therapist’s job is to help you attain your goals. Talk to them about your concerns, goals and how to maximize your exercises and time. The goal of having this surgery was to take care of the pain and return you back to the activities you enjoy. If you do not take responsibility for your rehab, who will?
The above information provides general ideas that I hope will allow you, your physician and your physical therapist to develop a custom treatment plan.
Eric O’Brien PT, MS, OCS